From the Guidelines
Diverticulitis diagnosis and treatment should prioritize a selective use of antibiotics, with a focus on high-fiber diet, hydration, and lifestyle modifications to prevent recurrence and reduce morbidity, mortality, and improve quality of life. The diagnosis of diverticulitis typically involves computed tomography (CT) scans to confirm the presence of diverticula and assess the severity of the condition 1. For mild cases of diverticulitis, treatment may involve oral antibiotics, such as ciprofloxacin and metronidazole, for 7-10 days, along with a clear liquid diet and rest 1. However, recent evidence suggests that antibiotics may not be necessary for immunocompetent patients with uncomplicated diverticulitis, and their use should be selective rather than routine 1. Some key points to consider in the treatment of diverticulitis include:
- The use of antibiotics should be reserved for patients with complicated diverticulitis, immunocompromised patients, or those with systemic manifestations of infection 1.
- A high-fiber diet, hydration, and lifestyle modifications, such as regular exercise and avoidance of smoking, can help prevent recurrence and reduce the risk of complications 1.
- Elective segmental resection should be considered on a case-by-case basis, taking into account the severity of the disease, patient preferences, and risks and benefits 1.
- Patients should be educated about the risks and benefits of treatment options, including the potential for complications and the importance of lifestyle modifications to prevent recurrence 1. Overall, the treatment of diverticulitis should prioritize a patient-centered approach, taking into account individual needs and circumstances, and focusing on reducing morbidity, mortality, and improving quality of life 1.
From the Research
Diagnosis of Diverticulitis
- Radiological evidence of inflammation, using computed tomography (CT), is needed to diagnose the first occurrence of diverticulitis 2
- CT is also warranted when the severity of symptoms suggests that perforation or abscesses have occurred 2
- Diverticulitis is classified as complicated or uncomplicated based on CT scan, severity of symptoms and patient history; this classification is used to direct management 2
Treatment of Uncomplicated Diverticulitis
- Outpatient treatment is recommended in afebrile, clinically stable patients with uncomplicated diverticulitis 2
- Antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence, and should only be used selectively 2
- Ambulatory treatment with oral antibiotics is safe, effective and applicable in most patients with tolerance to oral intake and with an appropriate family environment 3, 4, 5
- Treatment typically consists of oral antibiotics for 7-10 days, a clear liquid diet for the first 2 days, and pain control with oral acetaminophen 3, 4
Treatment of Complicated Diverticulitis
- Non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses 2
- Larger abscesses of 3-5 cm should be drained percutaneously 2
- Patients with peritonitis and sepsis should receive fluid resuscitation, rapid antibiotic administration and urgent surgery 2
- Surgical intervention with either Hartmann procedure or primary anastomosis, with or without diverting loop ileostomy, is indicated for peritonitis or in failure of non-operative management 2
Follow-up Care
- Colonoscopy is recommended for all patients with complicated diverticulitis 6 weeks after CT diagnosis of inflammation, and for patients with uncomplicated diverticulitis who have suspicious features on CT scan or who otherwise meet national bowel cancer screening criteria 2